We Die of Being Human, Not of Disease

April 12, 1994|By ELLEN GOODMAN

BOSTON — Boston. -- The obituary page doesn't say how the old people died. It merely lists the causes like a coroner's report or perhaps a police blotter. Each man or woman is duly, officially, assigned a disease.

The 91-year-old man, a ski enthusiast in his youth, died of a heart ailment.

The 88-year-old woman, a biographer in her prime, died of cancer.

The 102-year-old man, a machine-tool executive, died of pneumonia.

The closest anyone comes to dying of old age on the obituary page is the 97-year-old who died ''after a long illness.''

But the obits don't tell us how these people died. In pain or at peace. Surrounded by loved ones or alone. With a team of high-technicians trying to drag them back to life or with a process that we would call natural.

Even the photographs that accompany death announcements conspire to keep the reality of dying away from us. Once in a lifetime, literally, a man like essayist and biologist Lewis Thomas has his picture taken at death's door and a stark, translucent, face illustrates his end. For the most part, however, the portraits of the dead are brim-full of life.

These pages show what we know, that Americans have simply removed dying from the purview of the living. Our doctors have turned it into a disease, and we have handed the problem over to their science. Eighty percent of us now die in hospitals and for perhaps the first time in human history it is possible to arrive at the end of a long life having never seen another person die.

But finally, our aversion to the subject of dying is fading.

Exactly 10 years ago, then-Gov. Richard Lamm of Colorado created a furor by saying, in ill-chosen words, that the terminally ill elderly had ''a duty to die'' rather than hang on to machine-tethered immortality. We have to be careful, he tried to explain, that ''we don't impose life on people who, in fact, are suffering beyond the ability for us to help.''

That radical sentiment is almost common today. In the intervening years we've seen a political movement for ''death with dignity.'' We've seen a textbook published on how to commit suicide. Jack Kevorkian and his supplicants have forced us to pay attention.

Just weeks ago, Bill and Hillary Clinton made death the subject of their black humor about health care reform. Playing Harry and Louise, they gasped at the realization that under the Clinton health plan ''eventually we are all going to die.''

And now a book starkly entitled, ''How We Die'' -- a wholly unlikely candidate for best-sellerdom -- has risen to the top tier of the lists.

Those who reach for Sherwin Nuland's book are not seeking some false comfort in his descriptions of the horsemen of death -- from cancer to heart disease -- and the precise ways they carry away life. They are attracted, rather, by his humanity and eloquence in the service of honesty.

Mincing no words, he writes of our desire for a swift death during sleep or a ''perfect lapse into agony-free unconscious.'' But, he concludes, ''The great majority of people do not leave life in a way they would choose.''

Americans who consult with this doctor find no promises of extending the length of years through yogurt and vitamins. They find rather an argument about the naturalness and inevitability of aging and dying.

All this is striking proof of how the public conversation is shifting. We've gone from whispering the word cancer to talking openly about How We Die.

We now share the widespread fear of prolonged high-tech dying. Death now often comes with decisions to be made by us or for us. As Dr. Nuland writes, it is ''better to know what dying is like and better to make choices that are most likely to avert the worst of it.''

Indeed, his most passionate words are a personal statement: ''I will not die later than I should simply for the senseless reason that a highly skilled technological physician does not understand who I am.''

Finally, we are coming to our senses, especially the repressed sense that dying is the inevitable last chapter. When we banish dying to hospitals and to science, we forget what Dr. Nuland writes: that ''relevant event taking place at the end of our life is our death, not the attempts to prevent it.''

Death is the human condition. It's not medicine's failure to cure the disease of a 102-year-old.